Intrauterine Device Migrated into the Urachus: A Case Report.

Background: The intrauterine device is the most commonly used female contraceptive device, but the related complications of intrauterine devices are also common. Sometimes, intrauterine devices can cause uterine perforation, migrating into the abdominal cavity or other organs. At the same time, the intrauterine device may break into several small segments, migrate to distant organs, and even cause misdiagnosis.

Objective: This study assessed the role of laparoscopy in treating intrauterine device migration.

Design: This was a retrospective study involving in a review of a single case.

Setting: This study was conducted at Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University.

Participants: This study focued on a single case acout a 64-year-old female patient presented with repeated painless gross hematuria. She had a history of placing an intrauterine device and "removed the intrauterine device" in a local hospital for 20 years.

Interventions: Laparoscopic ureterectomy was chosen based on the specific findings from the computerized tomography scan and cystoscopy. Abdominal computerized tomography showed high-density foreign body under the abdominal wall, size 2.29×0.51 cm, showed signs of edema in the surrounding tissue, and it was connected to the bladder wall. High-density lesions in the urachus and urachus calculi were considered. Cystoscopy showed the bubble position on the top of the bladder was depressed, a dark foreign body seemed to be seen inside, and the local mucosa was congested. The urachus foreign body, the urachus stone, was considered.

Results: Computerized tomography examination showed a high-density space-occupying lesion at the position of the bladder and urachus tube. Cystoscopy showed local congestion at the top of the bladder, like urachus and dark foreign bodies, and no obvious abnormality in other parts of the bladder. Laparoscopy showed the urachus position was congested and edema, with local adhesion of the greater omentum and foreign bodies. The foreign bodies and surrounding tissues were removed by laparoscopic ureterectomy. Pathology showed tubular tissue, metal and plastic foreign bodies, fibrous tissue proliferation, and chronic inflammatory cell infiltration around the foreign bodies.

Conclusion: The intrauterine device is a common contraceptive tool, and intrauterine device rupture and migration are normal. Migration to rare locations can lead to misdiagnosis. It can be removed by endoscopy, and combined with imaging and pathological examination, a correct diagnosis can finally be obtained. The patients should be advised to undergo regular check-ups after the procedure. These cases may provide diagnostic reference for similar symptoms of intrauterine device migration.